Falls in the elderly Flashcards
What is the definition of a fall?
An event which causes a person to, unintentionally, rest on the ground or lower level
Result of interplay of multiple risk factors, becoming much more likely as people get older
Not a result of a major intrinsic event such as a stroke
Why are falls important?
- Falling is a cause of distress, pain, injury, loss of confidence, loss of independence and mortality.
- 65 and over have the highest risk of falling
- 1/3 of people 65 and over and 1/2 of people 80 and over fall at least once a year
How much does falls cost the NHS?
£435 million
255,000 emergency hospital admissions related to falls among patients aged 65 and over
Falls in hospitals are the most common patient safety incident.
240,000 reported in acute hospitals and mental health trusts in England and Wales
What are the potential consequence of falls in older people?
Biological:
Death, fracture, bruising, pain, soft tissue injury, long lies on floor
Psychological:
Distress, anxiety, depression, carer anxiety and abuse
Social:
Loss of independence and hobbies, dependence on others, family tension and stress and institutionalisation/moving to safer surroundings
If a elderly patient falls and is unable to get back up, what are the potential consequences of lying on the floor for too long?
Lying on the floor for more than an hour can result in:
Pressure sores
Rhabdomyolysis
Hypothermia
Pneumonia
At what time of day are falls most likely to occur?
Mid afternoon
What are the most likely ways that fall may happen?
41% shifting of body weight
21% trip or stumble
11% hit or bump
27% other causes
Name 5 common causes of falls - intrinsic factors
Syncope
Dizziness or vertigo
Seizures
Stroke
Visual impairment
Define syncope
Sudden, transient loss of consciousness due to reduced cerebral perfusion
Patient will become:
unresponsive
loss of postural control
Then will have a spontaneous recovery
Name 4 common causes of syncope
Orthostatic hypotension
Pain
Carotid sinus syndrome
Cardiac arrhythmia or ischaemia
Pulmonary embolism
When could a TIA/stroke cause syncope?
TIA/stroke very rarely cause syncope - they cause focal deficit
Only cause syncope in the case of brainstem ischaemia
Name 5 common causes of falls - Extrinsic factors
Poor lighting - especially on steps/stairs
Clutter around the home
Inappropriate footwear - open-backed slippers, high heels etc.
Incorrect use of walking aids
Pets or children
What is the acronym for common causes of falls?
DAME
D = Drugs
Poly-pharmacy, alcohol
A= = Age related changes
Gait, balance, sarcopenia, sensory impairment etc.
M= Medical
Syncope, Parkinsons, stroke etc.
E= Environmental
Obstacles, trailing wires, lighting
Give 2 examples of how a fall can be multi-factorial
Poor lighting + poor vision => fall
Postural instability + orthostatic hypotension => fall
How would you take a history for assessment of a fall?
SPLATTD
S= symptoms
P= previous falls
L= location
A= activity
T= time
T= trauma
D= drug history
How would you examine a patient after they has taken a fall?
General appearance
Gait and balance
Pulse rate &rhythm
Postural BP
Listen for murmurs – esp. aortic stenosis
Neurological examination
Look for signs of Parkinson’s disease
Check vision & hearing
Examine neck & head movements
Consider screening for cognitive impairment
What is Orthostatic “postural hypotension”
>20 mmHg fall in systolic BP and/or >10 mmHg fall in diastolic BP
within 3 minutes of standing with symptoms
Causes:
Drugs, chronic hypertension, volume depletion, autonomic failure (Parkinson’s, diabetes), prolonged bed rest, adrenal insufficiency
Treat the cause
Consider fludrocortisone or desmopressin.
What is Post-prandial hypotension?
A fall of 20 mmHg in systolic blood pressure after the ingestion of a meal
Can have effect for up to 90 minutes
Alter timing of anti-hypertensives
Lie down / sit down after meals
Caffeine, fludrocortisone, NSAIDs
How does visual impairment increase the risk of falling?
Common with increased age - multifactorial
Bifocals increase the risk of falling
Glaucoma
Macular degeneration
Retinopathy
Cataracts
What investigations would you order after a fall?
Bloods: FBC U&E
Thyroid
Glucose
B12 and Folate
Calcium and phosphate
Others: BP ECG ECHO CT head EEG
What is included in a multi-factorial risk assessment?
Identification of falls history
Assessment of:
Gait, balance, mobility and muscle weakness, osteoporosis risk, visual impairment and cognitive impairment
Neurological examination
Urinary incontinence
Home hazards
CV exam
Medication review
Give examples of a multi-factorial intervention
Physiotherapist = Strength and balance training
Occupational therapist = Home hazard assessment and intervention
Optician = Vision assessment and referral
GP = Medication review, modification/withdrawal
GP = Management of causes and recognised risk factors
